Why Trump, Congress must shore up Obamacare. And how

With the failure of Republican efforts to repeal and replace the Affordable Care Act, there is an urgent need to address the law’s problems. While Obamacare has worked out relatively well in some states, its record elsewhere has gotten steadily worse. In 18 states, there are two or fewer insurers offering policies on health care exchanges, preventing competition that might reduce costs. Worse, more than one-fifth of Americans live in counties where there is only one insurer or none at all offering policies on health care exchanges — and the policies typically hammer their holders with both high premiums and high deductibles.

This is because structural flaws in the Affordable Care Act encourage individuals to wait until they get sick or are injured before buying insurance, sharply increasing insurers’ costs and making their participation in state exchanges less worthwhile. These issues must be addressed constructively — by President Donald Trump as well as Congress.

The most important first step is for Trump to announce that his administration will commit to continuing $7 billion a year in cost-sharing reduction subsidies that have allowed 7 million low- and middle-income Americans to get health insurance coverage. But on Tuesday, budget director Mick Mulvaney told CNN that the Trump administration would make its decisions on a “month-by-month basis.” Insurers need far greater assurances on whether subsidies will continue now; as detailed in a recent Vox article, under the ACA, insurers are supposed to finalize their proposed 2018 premiums by Aug. 16 and make their final decisions about whether to offer 2018 policies in state Obamacare exchanges by Sept. 27.

To further shore up insurance markets, the Trump administration should also announce it will continue to enforce the individual mandate requiring every American to have health insurance.

The next step is constructive action by Congress. It’s not enough for Trump to continue Obamacare subsidies, which face a court challenge over whether they’re legal without congressional affirmation. Passing a bill authorizing the subsidies is the top priority of the House’s Bipartisan Problem Solvers Caucus, which has more than 40 members. The group also backs another smart idea: creating a federal “stability fund” to help states deal with the high cost of providing insurance to individuals with pre-existing conditions.

The House caucus has company. The ranking Republican and Democrat on the Senate health committee — Lamar Alexander of Tennessee and Patty Murray of Washington, respectively — have also vowed to work together to improve Obamacare.

The nation’s long-term goal should still be overhauling a health care system that costs more than those in other wealthy nations yet sees some poorer results. For now, though, Arizona GOP Rep. Martha McSally’s goal of hitting “singles and doubles” in fixing Obamacare makes sense. Let’s get on with it.